Provider Demographics
NPI:1023368024
Name:DEMAREST, SANDRA L (RPH)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:DEMAREST
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1139
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:WA
Mailing Address - Zip Code:98356-0020
Mailing Address - Country:US
Mailing Address - Phone:360-496-5902
Mailing Address - Fax:360-496-3215
Practice Address - Street 1:377 SOUTH 2ND ST.
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:WA
Practice Address - Zip Code:98356
Practice Address - Country:US
Practice Address - Phone:360-496-5902
Practice Address - Fax:360-496-3215
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist